Sharing Knowledge: Healthcare - Quality, Administration & Beyond

A Ramnujan Bose awardee, the author with more than a decade of experience in healthcare operations, projects and Quality, shares his experience, insights and thoughts on challenges, issues and solutions covering the large gamut of healthcare quality and administration. He is a Ramanujan Bose prize winner, NABH assessor, ISO 9001:2008 lead Auditor, IMC RBNQA examiner, faculty at various management colleges and member of various prestigious quality committees. He is the founder of Ekohealth

But as we all know the features adopted by Apple is usually never first in industry. Actually I don't remember apple utilising a feature before anyone else does. It always has been improving upon previously experienced technology.

Whether it's fingerprint security, display resolution, waterproof body, Bluetooth earphones etc were all improved upon and never introduced first in industry. Apple does not have the inherent DNA to take innovative risks specially since jobs is not around. We have all seen how apple without jobs has in history tried to bank solely upon their money minting offerings typically and end up losing.

That is what we are seeing now. Iphone was last introduced by jobs. There is nothing which has been introduced by Apple post jobs which has been hugely successful like the iphone. AirPods, lack of earphone socket, touch bar on mac, discontinuing jobs's favourite MacBook Air 11" have all been rejected by users by and large disappointing them to the core.

The only saving grace recently was dual camera bokeh in 7+ which apple didn't even anticipate that it would sell more,messing up the inventory management. And as analysed above the dual camera was not even first in industry by apple. Many brands have had that offering prior. And the same bokeh job can be easily done be any good cam app (I am waiting for the brilliantly demoed adobe bokeh app)

So what do I don't expect in iphone 10 which could have been worthy of apple's legacy:

1.Contactless Wireless charging as it's not introduced yet by other brands. Apple won't risk this as first comer. Tech still needs early adaptation by risk takers like real entrepreneurs on kickstarter.

2.Seamless edgeless display like the Samsung 8 as industry would ridicule them of copying.

3.TouchID inside display as no one has done that yet. 4.3D face recognition as its not introduced already. Apple wont risk this.

What I do expect in iphone 10:

1.Earphone jack to be back as it was the most ridiculous thing to do. Earphone jack is the most universal electronic component since wall socket. Imagine removing electric wall plugs and sockets and being "courageous" to make all things in house wireless for the whim and fancy of a company.

2.Waterproof to continue.

3.Touch ID to be (on side?) or back but in a more convenient location and make screen ratio bigger.

4.New OS 11 which will have battery improvement system & other improvements.

9.A display size bigger than 5.5" as that's in larger demand for apple

10.Dual camera even in 4.7 inch phone as they was saving grace for apple sale recently.

11.All glass body like iphone 4 to make it look different branding wise. Maybe even a sapphire glass option. Similarity in design has been biggest name for Apple as people buy apple also for pride of ownership. The loom change due to dual camera in larger phone was also reason for its better sale than the lower size version.

12.New Display material like OLED as that's in trend. 13. Iris scan(Maybe) as its already introduced by few brands & that Governments like India are pushing phone manufacturers to have it for UID.

So that's it folks.

Let's check back in June (or later in September if apple delays its anniversary launch) and I hope apple proves me wrong for the innovation part. My most desired feature is contactless wireless charging as it will greatly improve battery life, and dual camera in 4.7 inch too. It will be a disaster if they discontinue the 4.7 size and not reintroduce earphone jack.

In the meanwhile I'm seriously looking forward for pixel's price to drop as the price point is the only reason holding people from buying a fabulous google product.

Apple iphone sale drop trend will continue till the new phones are announced as only a breakthrough in offering can break the saturation and better features in offering by competition specially since Android OS is now almost at par with iOS.

Woah, what a detailed blog Amit. However sorry to say there are a lot of holes in it specially for the company market cap study as it needs an apple to apple study for retail giants vs export giants.

Also the main reason why prescribing generic will be an issue is government(govt) has not considered the active Vs inactive ingredient portion of the components in the drug as both matter sometimes for efficacy in terms of absorption time etc which has not been touched upon by you as the main issue here.

When we speak of generics it's mostly for core active molecule and the move by govt is based on international best practice to prevent financial moral degradation and to reduce nation's's economic wastage when technically something cheaper can be procured (http://www.health.harvard.edu/blog/generic-drugs-dont-ask-just-tell-201301075766). Imagine the potential to reduce insurance premium costs. United States of America and many developed nations are already considering options to do so.

Also the generic names are long names many times and do not include convenient combinations and that could be an issue.

We are facing this move by the government as it was expected some time due to the huge huge moral degradation which I have seen, researched and experienced during my ekohealth times. That is not a myth. The moral degradation is so rotten that even unaffording poor patients are prescribed unaffordable brands when a cheaper brand/generic is easily available. 80% of all debts in Indian Families are due to healthcare expenses & the major contributor to that expense is medicine.

There may be some rare breed of docs who don't take cuts etc, and a lot of docs genuinely won't know about many upcoming quality pharma firms if the ground marketing reach is inadequate. But the research clearly says the degradation is as high as 99% (forget research, we all know the ground reality. you yourself accepted that many hospitals get high MRP printed on cheap drugs for the high margin sale & don't even give a choice to patients to buy another cheaper drug)

I don't know why doctors are the first ones to react so negatively specially on generic medicines if pricing is not an issue. The haa hoopla just on quality is nothing but the insecurity of losing their commissions and nothing else. I can share studies which show that quality and efficacy don't change with different companies (check citation at the end). Also big pharma firms like ranbaxy do not many times adhere to quality and are fined and even small firms like mankind rise in popularity on word of mouth. So that is a different domain altogether and doctors need not worry about it. Govt and FDA will. I'm not even touching upon the rut in diagnostics domain.

I personally consume all medicines which are cheaper than popular ones. The biggest myth is that generics don't have a brand name is false. All medicines which are retailed at chemists have a brand name as per FDA rules and therefore all medicines are branded. Many times the same big manufacturer like Cipla manufacturers multiple different brands of same molecules at different MRP for different markets for retail and export with different MRPs.

So I feel doctors should be concerned with their fees and not the cuts from the sale of medicines. If quality is a concern, doctors can spend some time reading the efficacy reports, articles or peer review. There are some awesome pharmacovigilance portals which doctors can prescribe to know what brands are better effective based on actual practical use. Doctors will be surprised to know that there is hardly ever any difference among different brands/generics & even most popular brand sometimes has a problem and low cost brands equally never do.

It's time docs stand up with courage and hike their fees to what they deserve/desire and stop hiding behind the cover of some drug myths to show a cleaner face and blame everything on the government policies.

The quality will always remain an issue and the same issue needs to be dealt by govt for all manufactures whether their MRP is low or high, known or unknown brand/generic.

You yourself contradicted yourself by saying some hospitals buy at 300 and sell at 3500 as their own brands. Then why is that acceptable to the same doctors who cry on quality?

I sincerely hope there is a price cap on all medicines to bring a level playing field, so no MRP manipulation can happen. Price cap will bring better efficient process to manufacture and bring in stringent quality checks to prevent wastage & returns/rejections.
I had suggested to the govt to bring in a negative price list where only as exception some medicines are beyond price cap and by default all medicines are price capped. High time this happened to prevent any doctor favouring a particular brand only for sake of commissions.

Time has come to improve our moral compass & stop taking cuts or commissions or gifts or holidays to prescribe a certain medicine. Time has come to engage with patients and give them informed choices so they can buy a brand of medicine they want. Time has come to shed our skin of hypocrisy & accept the fact that only doctors can improve the confidence in the general public which is eroding at a pace we cant even imagine. Time has come to being a 'doctor sahab' we once used to be perceived as. That will go a long way as a great patriotic service for the nation.

Time has come to understand the ground realities of moral degradation which has led to a huge collateral damage unfortunately.

Additional readings:

http://bit.ly/generic1

A widely cited research on how generics and branded drugs have same quality and effectiveness and generics are for obvious malefic reasons being disregarded for monetary reasons.

Monday, February 6, 2017

So today's blog is on perception. Perceptions can be dangerous not just for personal stakes but a mindset if becomes a heard mentality can be harmful for the entire community.

I am an ardent fan of Steve Jobs and his creations at apple. I was surely among the first adopters for Apple products. I remember owning proudly the G4 450 Mac which was an amazing piece of technology in the year 2000. As expected that machine still purrs to life and powers on even today without a hitch. I've never had to take it for repairs ever. I later owned an iphone 4 and iPad and a MacBook Air in its initial launch. Those too never had any problems ever. There were eager customer waiting to buy these used beauties.
But then I just realised that every apple product I've bought since 2011 has needed repairs. Fortunately most of them were in warranty but still. I never had that issue with a product from HP or Nokia or blackberry etc. I now remember getting my iphone 5, 6 replaced a couple of times, MacBook Air components and Imac repaired or replaced and so on and so forth. All these apple products bought coincidentally in the last few years. The problem worsens when the warranty is over and just to have a look or diagnostics the service centres (atleast in India) charge large fees.
No doubt that apple has highly superior products (till the time it breaks down) but these frequent breakdowns brings the skeptic in me. I also realised Apple has highest number of repair extension programs for one problem or the other (for those who own apple products please do check internet under heading "repair extension program" for apple. Most of times your problem would be eligible for free repairs even if out of warranty).

Why am I writing this blog?
Main reason being - a loyal passionate customer can become the biggest hatter of a brand as expectations ran high. It therefore becomes a bigger responsibility of a trusted brand to reach out to its ardent brand ambassadors. This should be a learning for all brands no matter what type of an organisation you are.
A product for which you are always willing to pay more for needs to achieve certain benchmarks of quality which it always stood for.
And I see deteriorating customer service, no care attitude of apple brand lately with hundreds of community forum issues unresolved and no significant patches for talked about complains in various updates.
No doubt apple products are superior in experiential point of view for UI and feel, however (as per trends now) till the time repairs are needed.
I'm not saying products are infailable. But then apple did not become a cult for no reason. And I fear that cult ship fading and disappearing over the horizon of better competing brands and products on the envil.
I'm not even saying that apple does not respond to your grievance. It does and it takes a lot of effort and followup from the customer's side. But then it's more of a polite courstesy extended by apple than a genuine attempt to resolve an issue quickly and for good (for example my iOS spotlight issue is unresolved by Apple since more than a year)
This is the first time I'm considering switching to a Windows or android product for obvious reasons of meeting a certain expectation and not getting swayed by the cult and getting disappointed all over again.

The Rajiv Gandhi Jeevandayi Arogya Yojna (RGJAY), covering more than 5 million families in Maharashtra,is poised to cover more than 80 million people. Based on the immensely southern success story "Arogyasree" health scheme. Within this scheme patient get cashless surgeries and other treament from empannel private and public hospitals. The state sponsors this at a highly discounted premium with TPAs / insurance companies.

Fall outs:As mentioned in the story, there are bogus claims, unecessary treaments, and wrong escalated bills.This was expected, and i did mention this is in one of my previous blogs / articles.

Reasons: RGJAY does not follow in spirit the entire learnings of Arogyasree scheme.Arogyasree does not involve any TPA or third party mediation.The claim process has to be done with 24 hours. Any further delay leads to fraud and wrong claims and manupilation. All interaction is with the insurance company without any TPA.There is no variation in pricing and all hospitals have to follow the same pricing.There are clinical processes and instructions on what tests, medicines and lenghth of stay and preconditions have to be followed mentioned by Arogyasree, which is left to the hospital here. All centres are linked by common software and mandatory online MIS. You can actually see vacant beds and MIS online in public, making it transparent.There is a large call centre and support by local health workers on implementation of this scheme. There is on an avearge 15 day delay in TPA claim submission by hospital which leads to all the manupilations etc.

Way forward:This work should be given to insurance companies directly without involving TPA. The hospitals should follow a common cloud based / linked software for MIS and claim processing.Clinical proccess should be laid down to prevent unnecssary treamtents.hospitals whose claims have been found to be fraudulent should be banned /licence cancelled as an example. Arogyasree scheme should be replicated in same essence and operations.

All this is necesary as the faith in medicine, and doctors will soon go away.Such programs will not see the light of day if bad examples are reffered to. Ethics Ethic Ethics. All doctors should be made to stand in line and made to read the hippocratic oath again.Its High Time.

Author is social impact award winner & MD & CEO of EKohealth. Ekohealth has been fighting against referral fees, cut practice and striving to create a transparent health industry with cost comparisons and information to public to make them better informed.

Saturday, November 24, 2012

I was reading a fantastic article by professor Rodwin in New England Journal. Interesting perspective on the conflict of interest by medical practitioners who make investments in place they work. The primary objective logically will be ROI rather than patients interest. (Prof Rodwin's Article : http://bit.ly/U3mlIm)

When I shared this with my students & industry colleagues, some interesting arguments started.

Some practicing clinicians & hospital owners said that (sarcastically of course) that if Prof Rodwin is understood, then practicing medicine for fee itself is a conflict of interest. And I agree to that perspective too without any sarcasm.

Practitioners have been arguing since long time on why patients (consumers) just can't accept art of medicine & healing like any other profession & realize that like any other profession the care provider needs to earn a living too. Almost all surgeons have their own hospitals & physicians their own clinics. So the aspect of ROI (Return on Investment) & a commercial angle to seeing a patient always will arise. Afterall the hospital owners have their bills & salaries to pay. And some argue that offering costlier procedures for increased financial gains though is the norm today, is justified as it "apparently" offers significant advantages over the time tested older cheaper ones. Examples cited were minimally invasive laparoscopic surgery v/s open surgery. And the argument went on further that finally it is market forces which determine ones actions :) (me smiling)

No, I don't mind these responses. Actually, its an interesting argument.

However my concerns:For first time since last few batches, medical, dental seats are lying vacant to tune of 20 to 35%. 20 to 60 % of doctors & nurses don't clinically practice anymore (many of them are becoming administrators, & even changing industries :) I'm afraid the trend will continue. Fortunately you will see reduction in donation price & fees to fill seats in medical colleges. But over all there is huge competition from other industries like IT, offering better pay packets ( & for ethical work). Youth realize that. Ethical Work? Yes, youth realise that every investment needs to have a return. The youth spends a fortune & almost a decade in becoming a doctor. With restriction on marketing & publicity, the hierarchy of sorts (of unethical nature) starts to work in healthcare. The hospital pays to family physician a referral fee to influence a patient to visit them. This comes at an ever increasing cost. The ROI will demand naturally more tests, treatment, expensive brands of drugs & so on which may even not be required by a patient. I still remember in disgust how a GP never prescribed antacids (or made patient aware) when prescribing chloroquine. The patient was forced to come back for a second consultation for treatment of acidity. ROI in classic play.

I'm afraid, healthcare is soon going to see a major setback across the globe & in India specially as we will see mass exodus of doctors & nurses to foreign shores for better pay packets. & potential doctors & nurses choosing other professions.

There is a serious introspection needed. This is the time to change & start having a good intention. Intention to see good of patient & sincerely honour hippocratic oath.

My argument on conflict of interest on fee for practice is that in other industries for any harm to an individual there are strict penalties & legal actions imminent (for example life imprisonment for murder, harm), but there is a huge relief given to medical practitioners for such outcomes (death for example) on account of a wrong judgement call. Why? Because we are playing with human lives & trust. The way we honour a soldier for killing in larger interest of the nation, similarly a lot of wrong doing & bad judgement calls are ignored by court of law so that the medical practitioner keeps practising & uses he prior bad experiences to save more lives. Alas that gets lost somewhere in the so called ' fee for practice', right to earn a living.

I remember Dr Naresh Trehan in an exclusive interview on CNBC with my company Ekohealth's Director Nehha Rajpal, said that for success in healthcare the most import thing required is good intention. Else one should choose any other industry. Therefore we have likes of Devi Shetty who come up once in a while as a breather.

If it was for me, I would have made healthcare akin to armed forces. Government spends on it being essential services (Obama trying to do the same exactly for same reason). And there are time tested good examples from past & present. Singapore is worlds most successful public health model followed by NHS. There the citizens prefer to visit a government hospitals, being so good. In such systems, all medicos are hired (there are better opportunities for governance due to low population too, but... Then you can have more centres & resources too) So no conflict of interest arises as patient don't have to pay. India is different, rest of world is different. This discussion is still an interesting argument.

Obviously government can look at a nicely IT enabled nicely monitored PPP delivery at fixed pricing with fixed clinical protocols (like arogyasree)Obviously more clinical resources like doctors & nurses need to be created by removing red tapes, reasonable nationalistic rules governing medical/nursing colleges (3yr community professional course by govt is a right step. What can you do if doctors won't work even with bonds in villages. & bonds are not efficient & right way to keep doctors where they don't want to be)OBviously everyone could be insured in the interim to pay for care. Obviously all treatment should be free as matter of right of better living.

And I hope that day will come.

What is required is just a good intention.

Dr Akash S RajpalAuthor is CEO of Ekohealth (www.ekohealth.in)He is a ramanujan bose awardee for social impact & is working against fee splitting (referal fee / cut practice)
Sent on my BlackBerry® from Vodafone

Tuesday, September 4, 2012

I share my experiences at Singularity University at NASA Research Park, USA.

Singularity summer

Students
and diversity

Peter
& Ray & Firesides

Lectures
and insight by various faculties

Site
visits & Workshops

Team
Projects

Fun

Concluding
Remarks

Students and diversity

It was humbling to be among a highly diverse
class with students from 35 countries. Women represent 40% of the class and
that was positively a striking contrast to what I typically see back in India. It was
good to know that I was selected among the 3000 odd applications and was one of the 20
global competition winners.

Average age being 35, most of the students are
entrepreneurs; many of them have already started a company as early as 19 years
of their age. Sharing experiences and knowledge being a learning experience
every day, making you realize that ones achievement is not enough in comparison
to the rich background of the class, and that much has to be done in life.

All share a common goal - of creating an
impression on the global scene, and helping millions of people at the same
time.

Peter & Ray & Firesides

Most amazing part of the Singularity Summer
has been a close interaction with visionaries like Peter Diamandis and Ray
Kurzweil. It’s an immense pleasure to see the aura of passion for technology-change
for good in them, that it is nothing less than infectious.

Whether
its listening to Ray talking about increasing life expectancy, not worrying
about robots replacing human jobs, his predictions to the precise time and date
in future and how his positive influence of his father on his childhood made
him think the way he does was just an amazing experience. He however reiterated
that technology changes would not be able to eliminate the influence of sex
love and money. And he was serious about it.

While
Ray’s passion reflects in his unique style of calmness, Peter Diamandis just
exuberates with energy. Very approachable, and humble and it was an amazing
experience interacting with him. While everybody worries about privacy and
security due to Facebook and other social media sites,Peter has been positively insisting that such openness has been
the biggest neutralizer to threat of security everyone being there, creating a
more transparent community. He is a strong propagator of radical transparency and
reflected the same in his fireside chat with Philip Linden of Second Life
Virtual World.

The
Fireside sessions in late evenings of Peter Diamandis where he invited many
leading successful entrepreneurs for a close interaction is unforgettable.

Philip Rosedale
AKA Philip Linden of Second Life and his out of box ‘commit to pay’ crowd
source ventures like coffee&power, Eric Migicovsky of Pebble and how he
raised 10 million dollars on Kickstarter
site, Josh Kopelman’s marketing genius to rename a town to his company name ‘half.com’
which got sold to eBay later were amazing stories to listen to. It was
encouraging to hear from Philip Linden say that great ideas sound crazy or of disinterest few years before they happen.

Lectures and insight by various faculties

The core strength of the Singularity summer was the faculty and invited
guests to interact with the students. We had some amazing personalities
interacting with us on various subjects including exponentials of
Nanotechnology, Biotechnology, Robotics, Space, Health, policy law and ethics, Information
Technology, and many more. While we were excited to gain an insight into the
cutting edge technology, Marc Goodman reminded us of the dark side of the
technologies - be it stealing a persons DNA, or 3D printing Guns. It was chilling to hear his work
against terrorism & his insight on the technology used by terrorists in the
Mumbai attacks.

Eric Reis
of Lean Startup encouraged us not to be insecure of ideas being stolen, and instead
worry about execution, while Greg Maryniak told us about energy resources and
future of energy. Bob Richards discussed multiplanatary civilization, and Navin
Jain spoke about social enterprises. SR Das on economic modeling, Sushmita Gosh
from Ashoka Foundation, Catherine Mohir's concern on gradually shifting
agriculture land scape to developed countries, and Matt Ranen of GBN on
forecasting future were among many lectures which helped us form a vision for
our team projects which could help a billion people.

India and
Indian companies were frequently citied as good examples by many of the
faculty.

Interaction
with Hugo award winning science fiction writers like Verner Vinge, Greg Bear,
David Brin, was very engaging, I specially being an avid science fiction
reader.

Ben Goertzel
on Genral AI via skype spoke about problems with the Turing's Test & wozniak
cofee test and challenges to make AI better than humans.

Nano tech H2 fuel cells, terraforming desserts,
supercomputing, early disease detection indicates that this is a Nano decade
for sure.

Dan berry,
astronaut and space faculty shared his passionate story of his desire to be an
astronaut and how his persistence paid off.

The women
at Frontier Event was organized by Singularity University which had inspiring speeches
by women entrepreneur’s like Lakshmi Pratury of TED India and Kay Koplovitz
founder of channel-SciFi.

Peter Schwartz predicting space travel by year 2200 &
Bangladesh underwater by 2050, and exclusive revelation of Cambridge Decleration
by Philips Tevenlow that Humans are not the only conscious beings,
interaction with Dr Amy Lehman
of Lake Tanganyika Floating clinic were other highlites.

Insight
by Yasuyuki
Motoyama of Kauffman FDN that VCs invest typically within 70KMs of their base
was interesting to know.

An interesting coincidence
observed though listening to all these technologies was that ‘something is
happening at Global IT as an organism. Total transistors, web links are now similar
to a human brain synaptics now. Whether a super AI brain in making was
extensively discussed.

Site visits & workshops

Google site visit was a beautiful experience,
and I experienced up and close the great working environment it had. Interacting
with teams behind Google car and Google maps was exiting.

We visited Autodesk, flew real aero models, had
hands on with genetic sequencing during various site visits, built robots, moon
rovers, programed circuit boards, and much more.

Team project workshops by external faculty, marshmallow
challenge and an amazing session by Tom Wujeck & Maurice Conti was very
helpful in preparing for our team project.

The students made Ignite presentations, and I
did an ignite on use of the ‘Force Field’ as an answer to global grand
challenges.

Team Project:

My team project was called as ‘CARE9’ and addressed
Global Grand Challenge of Healthcare. The Team project integrates exponential
technologies like Artificial Intelligence and sensors to make an artificial
doctor to bridge the gap of inaccessible healthcare in remote corners. The
application also has an extension to monitor falls and fainting for care of
elders staying alone in developed world.

The team is strong and has diverse expertise
from fields of sensors, artificial intelligence, public health and policy,
Venture capitalists and others. Our team project already has got traction from
companies like Genentech.

Our Care9 team project was rated as the best
project with potential to reach 1 Billion dollar valuation in 10 years. We are
working towards formation of a formal company and making a business plan to get
funded.

Other exciting team projects in class included
Zero G drones for economical lab experimentation, Artificial Womb and many
others.

Fun

While were extremely busy, the diversity
called for a lot of fun. We were invited to the Tony Robbins Motivation event,
and many of us including me ended up doing the adventurous Firewalk. Tony
Robbins also came for a exclusive one on one interaction at the Singularity
University and it was very engaging.

We had various culture nights and the
Asian/Indian culture night was very popular.

I got to
participate in the annual San Fransisco Marathon, and had a lot of fun.

The class was very fun loving and ended up
with a surprising flash dance to entertain the stressed staff and management.
Video link -http://t.co/wQlEXKx6

We
had various competetions which my team won including a 1000$ Android
Application development opportunity, and other contests.

I got the
opportunity to test various products including a foldable electric Bike ‘Yike
Bike’

Concluding remarks.

The
Singularity Summer has been a great unforgettable experience. Thanks to
Ramanujan Bose Award that I could participate in this un-expectable journey of
unique over whelming knowledge of exponential technologies called as
‘Singularity University’

My
students in India have been following me and have insisted that I share my
experiences when I return.

I plan to
share such opportunities in schools and colleges as I feel the seed of
exponential technology to help one billion people need to be sown in the young
minds to affect in future.

Monday, May 14, 2012

In the United States the recent trends indicate that the uninsured population is rising and is at a high of 17 to 20% of population left uninsured. There the problems are very different and law suits against patients are common for un-paid bills which run in millions. Hospitals are also being sued by patients for aggressive payment collections methods for defaults and news articles are many citing incidents of payment sleuths from hospitals asking for money inhumanely in the emergency rooms from the uninsured.

Well the scenario is different here in India.

The insurance reach is less than 2%. And majority of payments are out of pocket.

However widespread grievance by a lot of INSURED patients is a little different.

They complain of jacked up prices when they informed the hospital that they were eligible for cash less services.

According to a recent survey as cited in Forbes, when the pricing for hospitalization was compared between insured and uninsured there was a striking upward billing of upto 40% for insured patients in comparison to cash paying patients.

This indicated obvious unethical billing and suspected collusion with many TPAs. This was bound to force many insurance companies to do away with TPAs and fixing certain costs of procedures.

The matter will only worsen over a period of time and will further lead to a disillusionment of patients from Insurance due to such instances and hassles, and the insurance penetration will not rise to a desired level.

With inflation and cost of health care rising, problems are going to worsen a lot leading to unutilized beds and non-competitive revenues and EBITAs. The problem of un-paid bills from TPAs to the hospitals and individual patients is on the rise. The reasons are many for the same but leads to a situation where either patients stay away from such hospitals, hospitals stay from such

TPAs and Patients stay away from getting insured.

However there is enough time to bring in trust among stakeholders:

Hospitals should look at long term solutions to acquire patients and not give into unethical referrals. Today majority of the hospitals pay 20% as referral fee, the competition will pay 30% tomorrow, and then how long will you up the scale? Effort based engagement with patients will build trust and cost of acquisition will be much lower. Leading to higher profit centres.

Hospitals should keep the tariff standardized for all kind of patients for the same class of beds. It should not change from opportunity to opportunity. The pricing for insurance too should not change.

In the long run Insurance companies will prefer such hospital who do competitive and standardized billing.Many hospitals now doing away with bed class wise exponential billing and only charge extra for the room type and not the services. This makes all stakeholders happy.

Hospitals should invest time in making good all-inclusive packages with no variable. Its not that it can't be done. This will increase trust and competitiveness.

Hospitals should list their prices transparently and on all its communication channels including the website.

Hospitals should not take legal action against any patient. This will be like axing ones own foot. It will only lead to bad publicity. A gesture of good-will shall create a word of mouth to compensate for your loss if any.

Train your staff, specially the billing and customer care. A nice gentle but persistent followup with patients or relative every day reminding of their outstanding will sort out billing issues in majority of cases.

It is advisable that a tactful dedicated team (depending on the size of hospital) be assigned for such tasks.

Focus on 'Customer satisfaction'. That is what will make you survive in the business of healthcare.

My take:
I guess unless govt is healthcare provider friendly there will not be many takers for creating a good quality health setup. Govt seems to become greedy when a pvt setup creates gold out of dust. The case seems to be duplicated in almost all professionally run centres now - seven hills, fortis vashi & others whoa re all in some trouble even with agreed MOUs. Govt needs to realize that no pvt setup will be there without profits for self sustenance even if it is a trust run centre. All prudent establishments who don't want to run on donations will want a self sustenance model. Govt should be happy that its city has such brilliant health setups catering to their obligation towards its citizens of providing excellent health facilities which they fail to do on their own.

Monday, April 16, 2012

I was at Raipur & Korba, Chattisgadh last few days to promote 'Ekohealth' through road shows. I had interesting interactions with the medical fraternity & other stakeholders. A lot of them were surprised when I told them that Ekohealth will not take any 'cut' from them if Ekohealth patients come to them. I said that someone had to begin ethical medical practice as unethical practice of referral fees is degrading the competence & faith in such a lovely profession. On this many practitioners put forward their pain points on how difficult it is to get patients without referral fees. Obviously, much of medical establishment is driven by doctors turned owners. Almost all of them are uncomfortable working for 'others'. This creates a problem. Almost none of them get time to write about their good work, give adequate attention to patients & this leads to a degrading practice over a period of time. Such doctors who were busy earlier are find lesser patients coming to them in many centres. They never invested in themselves. They never took opportunity to 'brand' themselves through publishing articles, creating patient forums, taking customer feedback & thus loosing an opportunity to act on it for appropriate course correction. This also leads to a desperate 'spegheti' marketing & advertisement which is unethical in a lot of ways, but also unfruitful. So I have always propagated my belief of handholding your patient as a 'customer' who expects 'satisfaction' like any other purchase of a product. Today customer is smarter than before & therefore the patient too, as they both are the same.One elderly gentleman during my interaction pointed out that in this case even writing articles, telling people how many amazing surgeries you have done, clinical outcomes etc is also 'marketing' & is therefore unethical. And he was very uncomfortable with patient being termed as 'customer'. On this I deliberated that doctors are themselves to blame for it. They made patients customer the day they started encouraging a 'referral fee'. This ultimately made costs higher & patient started counting value for the buck. This also paved way for more professionally run corporate setups. I told him that its absolutely fair that one's achievement be known to patients, else how would he know?And unless you write on internet or contribute to various publications sharing your research outcomes, & learnings from the experience how would your peers & patients know you exist. Writing well would increase confidence among all stakeholders & create ethical peer referrals & direct patients. I think he was convinced in the end.
Dr Akash S Rajpal
MD & CEO
Ekohealth Management Consultants PVT LTD